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Depression in Axial Spondyloarthritis and its Association with Disease Activity

Last updated: 06-20-2020

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Depression in Axial Spondyloarthritis and its Association with Disease Activity

Axial spondyloarthritis (axSpA) is a chronic rheumatic disease, which primarily affects the spine and other joints. It can be grouped into two types, radiographic (ankylosing spondylitis, AS) and non-radiographic (nr-axSpA.) Both types are associated with inflammatory pain and can involve functional impairment. As with many chronic conditions, depression is common among those living with axSpA; however the topic is not well studied, and reports of its prevalence vary greatly from study to study.

To give this topic more clarity, researchers conducted a systematic literature review, analyzing 16 international study findings to (1) better describe the prevalence of depression in axial spondyloarthritis patients, (2) investigate differences in those with radiographic axSpA vs. non-radiographic axSpA, and (3) compare disease activity and functional impairment of those who have depression with those who do not.

The studies collectively included 4,753 axSpA patients (2,857 with AS and 334 with nr-axSpA.) The depression threshold was analyzed using either the Hospital Anxiety and Depression Scale (HADS) or the Zung Self-Rating Depression Scale (SDS.)  

Study results showed that (1) 15% of axSpA patients studied suffered from at least moderate depression, with overall depression prevalence ranging from 11% to 64% depending on criteria and threshold used, (2) the prevalence of depression was similar between the AS and nr-axSpA groups, and (3) that those with depression had significantly worse disease activity, and greater functional impairment. This last finding was consistent across all studies reviewed.  

It is important that clinicians treating those with axSpA are also assessing depression in all of their patients, but especially in younger patients and those with severe disease activity and functional impairment, concluded the authors. Depression has been shown to worsen pain and may contribute to patients with depression reporting a higher level of disease activity and greater functional impairment. Additional studies are needed to further investigate the impact depression can have on treatment outcomes in axSpA.

October 11, 2018 is National Depression Screening Day. If you feel you may be at risk for depression or other mental health conditions, you can take an anonymous screening online at

For Crisis Intervention Resources and help, please visit and reach out.

You will find a recording of Clinical Health Psychologist Jana Bolduan Lomax, PsyD presenting on the emotional impact of living with spondyloarthritis, here.

Sources used and further reading:

Zhao, S., Thong, D., Miller, N., Duffield, S. J., Hughes, D. M., Chadwick, L., & Goodson, N. J. (2018). The prevalence of depression in axial spondyloarthritis and its association with disease activity: A systematic review and meta-analysis. Arthritis Research & Therapy, 20(1). doi:10.1186/s13075-018-1644-6

Iyer, V. (2018, September 26). In Axial Spondyloarthritis Patients, Depression Linked to Disease Severity. Retrieved from

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